%0 Journal Article
%T P10.03 Management of low-grade glioma: a systematic review and meta-analysis
%J Archive of "Neuro-Oncology".
%D 2017
%R 10.1093/neuonc/nox036.321
%X Introduction: Low-grade gliomas (LGG, WHO grade I-II) account for 16.9-22% of all primary brain tumors. Management of these tumors consists of surgery, sometimes followed by radiation and/or chemotherapy. A rigorous, quantitative evaluation of the literature investigating the management of LGG has never been published. Methods: We conducted an exhaustive, PRISMA-compliant systematic review of the literature from January 1966 to September 2016 comparing the association of chemotherapy, radiation, or extent of resection with survival and progression-free survival at 2, 5, and 10 years in LGG. Included studies were graded for quality using AAN criteria. Pre-specified data were extracted and summary statistics were calculated using the inverse variance method and random effects model. Results: Five studies (n=567) report on LGG patients treated with chemotherapy. The relative risk (RR) and 95% confidence intervals [95% CI] for death (chemotherapy vs. no chemotherapy) at 2, 5, and 10 years was 1.34 [0.85-2.12], 0.83 [0.64-1.09], and 0.77 [0.58-1.03]. RR for progression at 2, 5, and 10 years was 0.92 [0.64-1.33], 0.69 [0.55-0.87, p=0.001], and 0.58 [0.39-0.87, p=0.008]. A sensitivity analysis of OS including only class I and II studies showed a RR of death (chemotherapy vs. no chemotherapy) at 2, 5, and 10 years of 1.23 [0.72-2.08], 0.78 [0.58-1.05, p=0.1], and 0.69 [0.56-0.86, p=0.0006]. Among only IDH1-mutated patients, the RR of progression with chemotherapy compared to control at 2, 5, and 10 years was 0.48 [0.06-4.1], 0.27 [0.08-0.84, p=0.02], and 0.21 [0.03-1.59]. Ten studies (n=1918) provide data regarding the effect of post-operative radiation vs. delayed or no radiation. RR and 95% CI for death at 2, 5, and 10 years was 0.92 [0.53-1.58], 0.93 [0.60-1.43], and 0.99 [0.69-1.41]. RR for progression at 2, 5, and 10 years was 0.66 [0.51-0.86, p=0.002], 0.73 [0.61-0.88, p=0.0008], and 0.74 [0.60-0.91, p=0.005]. Twenty-three studies (n=3891) compare gross total resection (GTR) vs. subtotal resection (STR) in LGG. RR and 95% CI of death at 2, 5, and 10 years (GTR vs. STR) was 0.29 [0.17-0.52, p<0.0001], 0.39 [0.29-0.51, p<0.00001], and 0.50 [0.35-0.70, p<0.0001]. RR of progression (GTR vs. SR) at 2, 5, and 10 years was 0.37 [0.24-0.57, p<0.0001], 0.50 [0.39-0.64, p<0.0001], and 0.67 [0.53-0.84, p=0.0005]. Relevant prognostic factors were also analyzed. For all three treatment subsets combined, only 6 studies provided class I or II evidence, and then only for the OS endpoint. Conclusions: This analysis, the largest systematic review and only quantitative
%U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5463873/